Abstract
Objectives: To develop a clinically applicable predictive model to quantitate the risk of estimated glomerular filtration rate (eGFR) decline to ≤45 mL/min/1.73 m2 after radical nephrectomy (RN) to better inform decisions between RN and partial nephrectomy (PN). Patients and Methods: Our prospectively maintained kidney cancer registry was reviewed for patients with a preoperative eGFR >60 mL/min/1.73 m2 who underwent RN for a localized renal mass. New baseline renal function was indexed. We used multivariable logistic regression to develop a predictive nomogram and evaluated it using receiver-operating characteristic (ROC) analysis. Decision-curve analysis was used to assess the net clinical benefit. Results: A total of 668 patients met the inclusion criteria, of whom 183 (27%) experienced a decline in eGFR to ≤45 mL/min/1.73 m2. On multivariable analysis, increasing age (P = 0.001), female gender (P < 0.001), and increasing preoperative creatinine level (P < 0.001) were associated with functional decline. We constructed a predictive nomogram that included these variables in addition to comorbidities with a known association with kidney disease, but found that a simplified model excluding comorbidities was equally robust (cross-validated area under the ROC curve was 0.78). Decision-curve analysis showed the net clinical benefit at probabilities >~11%. Conclusions: The decision to perform RN vs PN is multifaceted. We have provided a simple quantitative tool to help identify patients at risk of a postoperative eGFR of ≤45 mL/min/1.73 m2, who may be stronger candidates for nephron preservation.
Original language | English |
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Pages (from-to) | 999-1005 |
Number of pages | 7 |
Journal | BJU International |
Volume | 124 |
Issue number | 6 |
DOIs | |
State | Published - Dec 1 2019 |
Keywords
- Adult
- Aged
- Aged, 80 and over
- Female
- Glomerular Filtration Rate/physiology
- Humans
- Kidney Neoplasms/complications
- Kidney/physiology
- Male
- Middle Aged
- Nephrectomy/adverse effects
- Renal Insufficiency, Chronic/complications
- Retrospective Studies
- Young Adult
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Ross, PhD, ScM, E. A. (Director), Devarajan, PhD, K. (Staff), Zhou, PhD, Y. (Staff), Zhou, MSE, PhD, Y. (Staff), Egleston, PhD, MPP, B. (Staff), Hasler, PhD, J. S. (Staff) & Zhang, PhD, L. (Staff)
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